Your bottom line is our top priority

We are your preferred partner for healthcare auditing, recovery and compliance.

Experience the DRG difference
Our Solutions

DRG claims management serves as your eyes and ears

Our expansive list of services include DRG, Outliers, SNF and APC validation and recovery solutions that proudly exceed industry standard.

01

DRG

Our expert team is skilled in diligently validating and resolving complex DRG coding errors and overpayments, resulting in accurate billing and reimbursement.

02

Outliers

Through our comprehensive Cost Outlier reviews we analyze itemized bills driving claims into an outlier status for additional payment to ensure that each charge is indeed entered appropriately.

03

APC

Outpatient services are not immune to the perils of inaccurate or incomplete coding. Our thorough auditing processes and systems represent health plans and their right to review.

04

SNF

In the world of nursing care, we make it our mission to leave no stone unturned in validating all claims and securing prompt recovery when necessary.

DRG Means More.

Breadth of Expertise

Pre-payment Solutions

Innovative Selection Process

Corporate Skills - Boutique Service

Proprietary Data-sifting Technology

Provider-verified Results

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Our Mission

Integrity matters

At DRG, we believe that you deserve better: Better processes, better communication, and better results.

We tailor each auditing process to meet our client’s unique strategic objectives, and employ innovative and forward-thinking solutions to meet their auditing, compliance and recovery goals.

Service. Transparency. Savings.

It’s what we bring to the auditing table

Our Unique Process

It pays to work together

We stand apart by ensuring compliance and integrity with provider-verified audit results.

  • Reduces appeals
  • Saves resources
  • Eliminates reversals
  • Establishes relationships
  • Smooth recovery
  • Superior results

Our unique process focuses on obtaining signed agreements that minimize friction and improve your bottom line.

Auditing Power

Knowledge is auditing power

Our team includes clinical auditors with AHIMA credentials in the HIM field and CCS certified; healthcare veterans with management expertise in health care delivery, medical economics, managed care; IT and development staff overseeing data integrity, coding and more; and support staff dedicated to serving you right.

What Our Clients Say

Clients testimonials

Manager, Special Investigations

Driscoll Health Plan, Texas

Any payer seeking an audit vendor should consider DRG Claims Management, they are an excellent choice. As the Manager of Special Investigations for the Driscoll Health Plan, my Team and I have been collaborating with them for almost 10 years on our yearly program of facility audits of DRG utilization and they remain our choice.

The services they provide are top rate and their level of customer service is outstanding. All their staff from the Executive Leadership team and everyone in the organization make their clients feel like they are the most important the company has every time we speak to them. They provide excellent tracking metrics as well as maintain and develop excellent working relationships with the providers audited.

They have always been very responsive to our requests and have always gone the extra mile to ensure that our auditing needs are met. I am confident that you’ll have a positive experience if you decide to purchase their auditing services and partner with them.

Chief Medical Officer

CenterLight Healthcare, New York

I have worked with DRG Claims Management for many years in two different health plans.

What really impresses me is their professionalism and scope of knowledge and particularly the ability to work so cooperatively with our hospital providers to see a case through as long as necessary to confirmed resolution.

They bring superior results with essentially little to no burden placed on health plan resources.

Sr. Manager, SIU Operations

National Medicaid Healthplan

The DRG Claims management has been providing DRG audit support to our company since 2016 and they have been outstanding since day one. Professionally, the DRG Claims Management team have a lot of knowledge and they have helped our company improve the rate of return as it relates to DRG audits.

Working with the team has been a great experience, not only from the professional side, but from the personal side as well. I love that they are always available and willing to help in a positive way when questions or requests arise. It is truly an enjoyment to work with this team.

Government Programs Manager

FamilyCare of Oregon

All aspects of working with DRG Claims Management team were very positive, from the initial start-up through ongoing operations and reporting. Having them as a knowledgeable partner made a great contribution to the health plan. Their professionalism and experience was evident from beginning and more importantly it remains consistent.

Assistant Vice President, Claims Compliance

HealthCare Partners New York

Our collaboration with DRG Claims Management has allowed us to create a highly successful audit program that meets our specific needs. Their team of skilled experts offers customizable solutions paired with high quality audit results and excellent customer service. The resulting combination surpasses by far the “one size fits all” products offered by other vendors.